(1) Single Use Column A
(2) Married Filing Joint Return Use Column A
(3) Married Filing Separate Returns Use
(4) Married Filing Separately on this
Adjustments and Voluntary Contributions from attached Schedule 760PY ADJ Line 24
Amended Return Check if Result of NOL
Check here if credit card payment has been made
Checking
Debit Card (Fees may apply)
Dependent on Another s Return
Enter spouse's full name on line below
For Local Use
I (we) authorize the Department of Taxation to discuss
Overseas on Due Date
Qualifying Farmer Fisherman or Merchant Seaman
Your Virginia income tax withheld Attach Forms W 2 W 2G 1099 and VK 1
(Claiming federal Head of Household? YES )
(Even if only one had income)
(mm/dd/yyyy)
*VA760P113888*
*VA760P213888*
2601039 REV 07/13
4a Column A and Spouse's on Line 4b Column A
65 or over
A Your Social Security Number
Add Lines 1 and 2
Add Lines 13 14 and 15
Add Lines 29 and 30
Add Lines 4a 4b 5 6 7 and 8
Additions from Schedule 760PY ADJ Line 3
ADJUSTED GROSS INCOME from Sch of Income Part 1 Line 7 Column 1
Amount of overpayment on Line 28 to be CREDITED TO 2014 ESTIMATED INCOME TAX
and Spouse if
and Spouse reported as taxable
appropriate column (See Prorated
Attach a complete copy of your federal tax return and all other required Virginia attachments
B Spouse's Social Security Number
Blind
Choose Direct Deposit or Debit Card
City Town or Post Office
Column A (Enter spouse s SSN above)
Combined 2013 Estimated Tax Payments (Include credit from 2012)
Combined Return
Combined Social Security for You
Complete the Schedule of Income first and be sure
Credits from Schedule CR Section 5 Line 1A If claiming Political Contribution Credit only check box
DATE OF BIRTH
Dates of VA Residence
Deductions from Schedule 760PY ADJ Line 9
Dependents
Direct Bank Deposit
Domestic Accounts Only
Due May 1 2014
Earned Income Credit Claimed on
EXEMPTIONS Enter the number
Exemptions Worksheet from Schedule
Extension Payment Enter amount paid on Form 760IP
Federal Return $ 00
federal return and received while a Virginia resident Claim in the same column
Filing Election
FILING INFORMATION
FILING STATUS (CHECK ONLY ONE)
Filing Status 2
Filing Status 4
Filing Status 4 ONLY
Firm s Name (or Yours if Self Employed)
Form 760PY (2013) Page 2
Form760PY
I (We) the undersigned declare under penalty of law that I (we) have examined this return and to the best of my (our) knowledge it is a true correct and complete return
I agree to obtain my Form 1099 G income tax refund statement electronically at www tax virginia gov instead of receiving a paper copy
If Line 19 is larger than Line 26 enter the difference This is the INCOME TAX YOU OWE Skip to Line 30
If Line 26 is larger than Line 19 enter the difference This is the OVERPAYMENT AMOUNT
If Line 28 is larger than Line 31 subtract Line 31 from Line 28 This is the amount to be REFUNDED TO YOU
If you owe tax on Line 27 add Lines 27 and 31 OR If Line 28 is an overpayment and Line 31 is larger than
Include Spouse if Filing
Income attributable to your period of residence outside Virginia from Schedule of
income on Federal Return $ 00
Income Part 1 Line 9 Column 3
Itemized Deductions paid while a Virginia resident See instructions
Line 28 enter the difference This is the AMOUNT YOU OWE Attach payment
Locality Code
LTD $
No International Deposits
of exemptions being claimed in the
of Income Part 2 )
Page 1
Please Sign
Preparer s
Preparer s Name
Preparer s Phone Number
Preparer s PTIN
Present Home Address (Number and Street or Rural Route)
Prorated exemption amount from Schedule of Income Part 2 Line 11
Qualifying Age Deduction Enter Birth Dates above Complete Age Deduction
reported as taxable income on federal return and attributable to your period of
residence in Virginia
Savings
See instructions before completing line items
Social Security Act and equivalent Tier 1 Railroad Retirement Act benefits
Spouse
Spouse
Spouse From
Spouse s Birth Date (mm dd yyyy)
Spouse s Business Phone Number
Spouse s Signature (If a joint return both must sign)
Spouse To
SPOUSE'S First Name (filing status 2 or 4)
Spouse's Last Name Check if deceased
Spouse's Virginia income tax withheld Attach Forms W 2 W 2G 1099 and VK 1
standard deduction from Standard Deductions Worksheet in instructions
Staple check or money order here
Staple Forms W 2 W 2G 1099 and VK 1
STAPLE HERE
State
State and local income taxes on Federal Schedule A and included on Line 11
State income tax refund or overpayment credit reported as income on your
Status 2
Subtract Line 12 from Line 11 if claiming itemized deductions Otherwise enter
Subtractions from Schedule 760PY ADJ Line 7
Suffix
Tax amount from Tax Table or Tax Rate Schedule
Tax Credit for Low Income Individuals or Virginia Earned Income Credit from Schedule 760PY ADJ Line 17
this return with my (our) preparer
to submit it with your Form 760PY
Total credit for taxes paid to another state from Schedule OSC
Total payments and credits Add Lines 20a 20b 21 22 23 24 and 25
Total Tax Add Line 18 Column A and Line 18 Column B
Use Column A: You Column B: Spouse
Use Only
Va Dept of Taxation
Virginia Adjusted Gross Income (VAGI) Subtract Line 9 from Line 3
Virginia Part Year Resident Income Tax Return
Virginia Taxable Income Subtract Line 16 from Line 10
when using Filing Status 4 ONLY Otherwise claim Your Age Deduction on Line
Worksheet in instructions Enter Spouse's Age Deduction on Line 4b Column B
You authorize the Department to issue a Debit Card if the Direct Deposit section below is not completed
You From
You Include Spouse if
you reported the income on Line 1
You To
You/Spouse
Your Bank Account Number
Your Bank Routing Transit Number
Your Birth Date (mm dd yyyy)
Your Business Phone Number
YOUR First Name
Your Home Phone Number
Your Last Name Check if deceased
Your Name
Your Signature
Your SSN
ZIP Code